Performance How do you know your council is performing well in adult social care? Why do you need to know?

Councils are responsible for their own performance and for leading the delivery of improved outcomes for local people in their area. Lead members will want to enable their councils to perform well in adult social care and to manage any risk.

Councils have the best chance of improving their services when they understand their own strengths and areas for improvement and take steps to deal with any problems.

Sector-led improvement (SLI) is the approach to improvement put in place by local authorities, and sector-led improvement in adult social care has been proactively embraced.

How do you know your council is performing well in adult social care?

Getting the culture right Effective performance management works best in a culture in which individuals and groups take responsibility for the continuous improvement of services, and are prepared to be open with each other. In an open culture, it is also possible to learn from mistakes. As lead member, you can give a lead in promoting and modelling this culture.

You will wish to work with other authorities in your region to compare your performance and to share good practice around improvement. Peer challenges arranged by the Local Government Association (LGA) or within the region form a significant part of the sector-led approach to improving and performance managing services, including adult social care.

Getting the systems right Performance management, and the reporting systems and data on which it is based, can help elected members and chief officers to ensure the quality and effectiveness of their council’s work and allows the public to make judgements about services.

Each council will have a system for managing performance throughout the organisation. If performance management is to work well the links between the different parts of the system need to be strong – and everyone needs to trust each other. To foster this, a good way to approach performance indicators is to be “curious” rather than judgemental.

The current financial pressures mean that local authorities need to reconfigure services fundamentally to achieve the budget reductions required of them while continuing to provide the best possible quality of care: achieving the best possible outcomes, as efficiently as possible. Ideally, your performance management systems should support this by measuring whether value for money is being achieved both for the people who receive care and support and those that care for them, and for the wider community.

You will need to ensure that your council has robust management information and quality assurance systems. This does include up-to-date and user-friendly IT systems. Investment in IT systems can seem hard to afford – but can ultimately save money, if it helps staff to be more efficient and helps the council to understand its business better. Poor quality data (due to poor day-to-day recording) is one of the things that most hampers good performance management.

You might notice that some of the evidence and indicators raise more questions than they answer. It is sometimes necessary to use measures or performance indicators that are ‘proxies’ for longer term outcomes - or which give only rough clues that something may not be working well. In some cases there is no easy way to assess the current situation – and some final outcomes will only emerge in the long term. On some occasions, you might decide to arrange or commission a bespoke investigation – to dive more deeply into something you feel concerned about.

Measuring progress Service transformation and innovation means new organisational and cross-organisational structures have been created in social care. Performance management can be a tool for assessing progress towards collaboration and integration across council services, with public health and the NHS.

It will also help in getting a vital understanding of other organisations’ performance drivers, risks and how they link in with local government.

In adult social care, promoting closer integration with the NHS is a statutory duty of health and wellbeing boards. The health and wellbeing board can be a useful forum to establish common objectives and benchmarks that will be collectively monitored and assured across services and with the NHS. Your local Better Care Fund (BCF) plan is likely to be the most important plan in this respect – and standardised monitoring reports will be available.

This requires better integration in performance management between adult social care, children’s services, public health and NHS programmes – and also the need for a place-based approach drawing on all the services available in an area.

The Care Act 2014 also requires councils to exercise their functions under the legislation with, “a view to ensuring the integration of care and support provision with health provision and health-related provision” where so doing promotes the wellbeing of people with care needs and their carers, contributes to prevention, or improves quality.

The Care Act also seeks to embed a culture of person-centered care, with the aim being to enable people to live independently for as long as possible. Your performance framework should measure how well your council is embedding the principles and overarching objectives of the reform of social care and not just the not just implementing the process and structural changes outlined in the Act.

All of this requires the need for a place-based approach drawing on all the services available in an area - and thus better integration in performance management between adult social care, children’s services, public health and NHS programmes.

Sector led improvement is based on the underlying principles that local authorities are:

- responsible for their own performance
- accountable locally, not nationally
- have a sense of collective responsibility for the performance of the sector as a whole.

To achieve the above, councils should collaborate through sharing of best practice, and actively welcome peer support and benchmarking. The role of the Local Government Association (LGA) is to provide tools and support for sector-led improvement. For more information on these, see the resources below.

### Key messages

**Fully engage with the sector-led improvement programme and its networking and learning opportunities through your director with responsibility for adult social care (DASS), in your lead member regional network and other regional forums.**

**Champion a culture of openness and continuous learning and improvement – and above all, a culture that listens to people’s own views and experience. Specifically:**

- develop a good working relationship with your local Healthwatch organisation
- keep up to date with changes to the Care Quality Commission and the regulatory framework for social care
- see complaints and safeguarding referrals as a way of gaining views from your community on how to improve services.

**Be aware of the potential risks facing adult social care, ensure these are reflected in your corporate risk register, know what is being done to mitigate them and take them fully into account in your decision making.**

**Develop an understanding of the key available data to be confident about performance and the risks to performance.** In particular, understand how your expenditure, costs and financial pressures compare with others. (See Further Resources below for the risk awareness tool and the advisory tool on risk developed by the Association of Directors of Adult Social Care (ADASS) and the Chartered Institute of Public Finance and Accountancy (Cipfa)).

Be partnership-oriented. Understand, in particular, how the performance of adult social care and NHS services are dependent on each other, and that there is a shared imperative to prevent health problems and to support people in their own homes ie containing admissions to ‘institutional’ services like hospitals and nursing homes. (See also the ‘Must Know’ on integration.)

Be aware of key areas of performance for your local NHS – especially those which Adult Social Care can help to address. This includes emergency admissions to hospital, delayed discharges from hospital, and the success of reablement and rehabilitation services that promote people’s recovery after a hospital episode.

Focus on the outcomes for people who use services and their carers and on their own experience, as enshrined in the Care Act. There are many ways of doing this but the Adult Social Care Outcomes Framework (ASCOF) indicators, most of which are based on annual customer surveys, are a good starting point.

Ensure that your and your partners’ commissioning strategy is outcomes-based, ie that providers you commission are assessed on the basis of outcomes they achieve for your service users and their carers.

Your council officers should be producing robust ‘market position statements’. These will help you understand the social care and housing markets in your area and how they may need to change in response to changing need.

Understand councils’ responsibilities in relation to the safeguarding of vulnerable adults, and the principles of the LGA’s ‘Making safeguarding personal’ (see Useful links).

Ensure you have access to the views of frontline staff, partners, providers, service users and carers on your current strengths and areas for development – and use your local knowledge and networks to drill beneath the data.

Be aware of the pressures that might be facing your front-line staff, and ensure this is monitored. For example, ask about how long people wait for an initial assessment, how long it takes to arrange people’s care packages, and how regularly people are reviewed.

Be aware of the main health and social problems affecting your community, which might impact the demand for adult social care. Understand how ‘social’ factors like poverty, poor housing and social isolation might be contributing to these problems. Explore how Public Health is seeking to address these issues – and how a ‘joined up’ approach might be beneficial.

Develop a good working relationship with your council’s scrutiny function for social care which may include a remit for health (see the Must Know on working with scrutiny). Questions to consider

Questions you may wish to consider when exploring how well your council is performing in adult social care:

• How do you know how well adult social care services are doing in your authority?

• How often do you discuss performance and finance with the director and her/his senior management team? Do you regularly discuss strengths, weaknesses, opportunities, threats and risks to services?

• Do you understand the reports on performance and finance you receive or could they be presented in a more comprehensible format and language?

• Do you meet with other Cabinet members within the region (and with other directors)? What are you learning from them about best practice elsewhere and how your council’s performance compares?

• Do you understand and discuss with your director the financial challenges faced by adult social care over the next four years including the impact of increasing demand and the possible ways in which adult social care could make further savings in line with corporate savings targets? Do you understand how savings might impact on service users and carers?

• What are service users and carers saying to you about performance of adult social care? How do you involve them in reviewing services?

• Are you clear what you would want to say to opposition members, the public, the local NHS about the performance of adult social care?

• Are you clear about your duties under the Care Act and how it is being implemented in your authority?

• How do you work with your local Safeguarding Adults Board to identify safeguarding risks and how they are addressed, and to agree common objectives and outcomes and monitor progress towards them?

• How do you monitor and assess progress towards integration with the NHS and achieve added value through collaboration with public health and other council departments? Is there more you can do to develop a cross-departmental and cross-sectoral approach to performance management?

• Are you making the best use possible of LG Inform the LGA’s free and interactive online reporting and comparison tool based on council areas? www.local.gov.uk/our-support/benchmarking-data-lg-inform

• There is a range of LGA reports available on the tool, across health, wellbeing and social care themes: www.local.gov.uk/our-support/benchmarking-data-lg-inform What further resources are available?

Key resources The Association of Directors of Adult Social Care (ADASS) worked with the Chartered Institute of Public Finance and Accountancy (CIPFA) to develop an Advisory Risk Tool to help councils assess their financial risks: www.cipfa.org/socialrisktool

A range of LGA programmes seek to help your council make efficiency savings and generate income. A specific programme on health and adult social care efficiency includes information on efficiency opportunities in integration, public health, commissioning, adult social care and learning disabilities: www.local.gov.uk/our-support/efficiency-and-income-generation/care-and-health-efficiency

The LGA adult social care risk awareness tool supports health and care system leaders in targeting limited resources on the right issues in social care and identifying mitigating action to address their most pressing risks: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/financial-and-sustainability-risks/managing-risk

The Towards Excellence in Adult Social Care (TEASC) programme (now ended) and Think Local Act Personal (TLAP) programmes produced a self-assessment toolkit in 2014 to enable councils to assess to what extent they are making best use of resources in adult social care: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/financial-and-sustainability-risks/managing-risk/self-assessment-toolkit

Adult Social Care Outcomes Framework (ASCOF) indicators has data for your own authority: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/375431/ASCOF_15-16.pdf

Key data tools and resources: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/information-tools-and-resources

General resources in care and health

Care and health efficiency: www.local.gov.uk/our-support/efficiency-and-income-generation/care-and-health-efficiency

Care and health improvement: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement

Informatics and integration: www.local.gov.uk/topics/social-care-health-and-integration/informatics

Financial and sustainability risks: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/financial-and-sustainability-risks

Market shaping and commissioning: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/care-and-support-reform/implementation/general-duties/market-shaping

Resources on integration: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund

Leadership of health and wellbeing: www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/health-and-wellbeing-systems

Lead member development opportunities: www.local.gov.uk/lead-member-development

Public health and prevention: www.local.gov.uk/topics/social-care-health-and-integration/public-health Safeguarding:\
www.local.gov.uk/topics/social-care-health-and-integration/adult-social-care/safeguarding-resources

Sector led improvement:\
www.local.gov.uk/our-support/our-improvement-offer

Sustainable funding for adult social care:\
www.local.gov.uk/topics/social-care-health-and-integration/adult-social-care

Systems resilience\
www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/systems-resilience

Principal advisers are the LGA’s focal point for discussions with councils about their improvement needs and the support available:\
www.local.gov.uk/our-support/lga-principal-advisers

Related ‘Must Knows’

How do you know you are making progress in the personalisation of adult social care?

How do you know your council is actively promoting integration of health and social care?

How do you know your council is being effective in keeping people safe?

How do you know you are making the best use of scarce resources?

How do you know that you are implementing care and support reforms effectively?

How do you know you are getting the most out of your relationship with health overview and scrutiny?

www.local.gov.uk/topics/social-care-health-and-integration/adult-social-care/must-knows-lead-members-adult-social-care

Updated April 2017